NPIMap

Organization Active NPI

Belvidere Rehab & Sports Medicine

  • Physical Therapist
  • Belvidere, IL
National Provider Identifier
1619922515
Registry record updated Jan 8, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
060-008176 Issued in IL
Legal business name
BELVIDERE REHAB & SPORTS MEDICINE
Practice address
1255 Logan Ave
Belvidere, IL 61008-4001
Phone
(815) 547-4733
Fax
(815) 547-9733
NPI assigned
May 23, 2006
Last updated
Jan 8, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
David A Black, PT, MS, OCSNPI 1508874165
Title
Owner/Executive Officer
Phone
(815) 227-1700

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 060-008176 IL Primary

Addresses

Primary practice location

1255 Logan Ave
Belvidere, IL 61008-4001

Mailing address

2662 McFarland Rd
Rockford, IL 61107-6806
Phone (815) 547-4733

Other identifiers 1

IdentifierTypeStateIssuer
060-008176OtherILPROFESSIONAL LICENSE

National Provider Directory

National Provider Directory

Locations

1255 Logan Ave
Ste B
Belvidere, IL 61008
Phone (815) 547-4733

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357603200000",
    "number": "1619922515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2662 MCFARLAND RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611076806",
            "telephone_number": "815-547-4733",
            "fax_number": "815-547-9733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1255 LOGAN AVE",
            "city": "BELVIDERE",
            "state": "IL",
            "postal_code": "610084001",
            "telephone_number": "815-547-4733",
            "fax_number": "815-547-9733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BELVIDERE REHAB & SPORTS MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2013-01-08",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER/EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "815-227-1700",
        "authorized_official_credential": "PT, MS, OCS"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "060-008176",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROFESSIONAL LICENSE",
            "identifier": "060-008176",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Belvidere, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.